Nicholas Kusnezov, MD, John C. Dunn, MD, Stephen A. Parada, MD, Kelly Kilcoyne, MD, and Brian R. Waterman, MD
Authors’ Disclosure Statement: The authors report no actual or potential conflict of interest in relation to this article. The authors are employees of the US government. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the US Department of Defense or the US government.
Continuous variables were compared using statistical means with 95% confidence intervals (CIs) and/or SDs. Categorical data were reported as frequencies or percentages. Univariate analysis was performed to assess the correlation between possible risk factors and the primary outcome measures. P < .05 was considered statistically significant.
Results
Demographics
We identified 24 service members (26 shoulders) who had undergone anatomical TSA during the study period (Table 1). Mean (SD) age was 45.8 (4.5) years (range, 35-54 years), and the cohort was predominately male (25/26 shoulders; 96.2%). Most cohort members were of senior enlisted rank (14, 58.3%), and the US Army was the predominant branch of military service (13, 54.2%). The right side was the operative extremity in 7 cases (26.9%), and the dominant shoulder was involved in 6 cases (23.1%). Two patients (8.3%) underwent staged bilateral TSA. Most patients (76.9%) underwent TSA on the nondominant extremity.
Surgical Variables
TSA was indicated for post-instability arthropathy in 13 cases (50.0%), posttraumatic osteoarthritis in 7 cases (26.9%), and unspecified glenohumeral arthritis, which includes primary glenohumeral osteoarthritis, in 5 cases (19.2%) (Table 2). One case was attributed to iatrogenically induced chondrolysis secondary to intra-articular lidocaine pump. Twelve patients (46.2%) had at least 1 previous surgery. Of the shoulders with instability, 10 (76.9%) had undergone a total of 14 surgical stabilization procedures—10 anterior labral repairs, 2 posterior labral repairs, and 2 capsular plications. The other shoulders had undergone a total of 18 procedures, which included 4 rotator cuff repairs and 3 cartilage restoration procedures.
Clinical Outcomes
Mean (SD) follow-up was 41.0 (21.3) months (range, 11.6-97.6 months). All but 1 shoulder (96.2%) had follow-up of 12 months or more (the only patient with shorter follow-up was because of MEB), and 76.9% of patients had follow-up of 24 months or more (4 of the 6 patients with follow-up under 24 months were medically separated) (Table 3). In all cases, mean ROM improved with respect to flexion, abduction, and external rotation. At final follow-up, mean (SD) ROM was 138° (36°) forward flexion (range, 60°-180°), 125° (39°) abduction (range, 45°-180°), 48° (19°) external rotation at 0° abduction (range, 20°-90°), and 80° (9.4°) external rotation at 90° abduction (range, 70°-90°). Preoperative flexion, abduction, and external rotation at 0° and 90° abduction were all improved at final follow-up. The most improvement in ROM occurred within 6 months after surgery.
Overall patient satisfaction with surgery was 92.3% (n = 24). Ultimately, 18 (72.0%) of 25 shoulders with follow-up of 1 year or more were able to return to active duty within 1 year after surgery, though only 10 (45.5%) of 22 with follow-up of 2 years or more remained active 2 years after surgery. Furthermore, 5 patients (20.8%) were deployed after surgery, and all were still on active duty at final follow-up. By final follow-up, 9 (37.5%) of 24 service members were unable to return to military function; 7 had been medically discharged from the military for persistent shoulder disability, and 2 were in the process of being medically discharged.
In all cases, SRPS improved from before surgery (5.2 out of 10) to final follow-up (1.4). At final follow-up, 22 patients (88.0%) reported mild pain (0-3), and no one had pain above 6.
